CASE OF SNAKE-BITE. Communicated
by
J. Fayrer, M.D., C.S.I.
I am indebted to Major C. A. MoMahon, Officiating Commissioner of Hissar, for the following very interesting account of the bite of bungarus ceruletis, in which cnse of death from hematuria was a prominent symptom, and where life seems to have been prolonged by the internal administration of stimulants. a
From Major C. A. MacMahon to Dr. Fayuer. T enclose an interesting account of a death from snake-bite. Mr. Davis, a customs' patrol, was bitten on the 31st August, (evening) and did not die until 11 a.m. on the 3rd September, having been kept up by ammonia and brandy all that time. The case is interesting, because Mr. Davis bad skilful treatment from the first, and the most approved remedies appear to have been applied. Mr. Davis became perfectly insensible almost immediately after he was bitten (showing that the poison was powerful and active) and yet he was restored, not only to consciousness, by the internal administration of ammonia and brandy, but he became sufficiently well to do some work, and sign some official papers, (the latter part is not mentioned in the the influence of the poison having been accounts I send you) checked for so long, one would hardly have anticipated a fatal termination about sixty-three hours after the poison was received into the system. It almost seems as if when a man is being bitten by a full-grown cobra, or krait, stimulants only postpone the fatal hour. The case is an interesting one, and I shall be glad to hear your opinion on it. The snake was evidently a krait. IIow ignorant men are of what snakes are deadly and what are not! Mr. Davis surely did not know. The two accounts T enclose are by Mr. Edwardes, District Superintendent of Police, Rohtuok, and the Sub-Assistant Surgeon of Hansi. I think they give, taken together, a very full, complete, and accurate account of the case.
THE INDIAN MEDICAL GAZETTE.
12
Statement of Mr. F. N. Edwardes. On the 31st August, 1871, I was on my tour of inspection at police station Mahim in this district, and on the customs line. A Mr. Davis, an assistant patrol, went out patrolling on foot in slippers in the evening, and returned at 8-30 p.m.; as he entered the gate of the compound, lie was bitten on the instep by a small snake, a karite or krait, or kerite. He had time to kill the snake, which was about two feet long, of a yellowish color, ?with blackish stripes across its back with his slipper. On Mr. " thuk" Davis being bitten, he called out to the guard at the (or weighing house,) to bring a lattie, and by the time the men readied a distance of not 100 yards, Mr. Davis was insensible ; they brought him to me at 8-30 p.m., or a few minutes after he was bitten, with the part bitten bleeding and a string tied under his knee, which 1 fancy he himself tied. I gave him ammonia and brandy in a wine-glass, cut the part where he was bitten with a penknife and rubbed ammonia into it; on my giving him the second or third dose and rubbing his foot with ammonia and having him walked about, he came round, and at 9 p.m. was all right and perfectly sensible. I still kept walking him about and giving him small doses of ammonia at short intervals,?first with brandy and afterwards without, as he did not like the brandy. About 10 p.m. I allowed him to sit down in a chair, he then became a little sick, but came round again. I left him at 11 p.m. perfectly sensible, and the only thing he complained of was a pain in his leg. I' was obliged to come into Rohtuck and was myself unwell. Shortly after Mr. Davis was brought in and after he came round, I thought it as well to send for toe customs' native doctor at Hansi, and wrote him a purwanah, ordering him to come to Mahim at once, and on my reaching Rohtuck, I wrote to Mr. Davis' brother, telling him of the case and advising him to go out; he went out on the 1st September, and tells me found his brother very well, but complaining of the leg being tied up and wishing to open it; he remained perfectly sensible and well that day, that night, the next day, the 2nd September, and that about 1 a.m. of 3rd September, began vomiting; at first ho thought it was nothing, but on his vomiting a second time lie got up and attended to him. On his asking his brother how he felt, he said that he found his chest paining him a great deal and complained of suffocation; after this lie tried to vomit again, by putting his finger down his throat, but failed. The native doctor was present, and continued giving ammonia with brandy. He after this once fainted and began to get weaker and weaker, and after about 3 a.m., he did not speak, and died about 11-30 a.m. On the 3rd September, Mr. Davis states, that after he fainted, he got convulsive three times, that on the 2nd September, about 3 or 4 p.m., he remarked that his brother was passing blood in the urine, stools, also from the part bitten, and vomiting. Mr. Davis states that he remarked the blood getting blacker and blacker as death approached.
Rohtuck,
6th
October, 1871.
Statement of case
by
Sub-Assistant Surgeon B. R. Paul.
"With reference to your docket No. 773, dated 9th instant, I have the honor to submit the following particulars of Mr. E. F. Davis's lamentable death, which occurred on the 3rd
ultimo,
at 11
a.m.
On the 31st August, 1871, Mr. Davis after taking his dinner at 8 p.m. with Mr. Edwardes, Assistant Superintendent of Police, Rohtuck, (who had come to Mahim on his tour of inspection) went out patrolling on foot towards the Hansi line, and on his return, not very far from his bungalow, just near the nalca,* he saw a small, thin, black and white snake lying on the road, which lie attonipted to kill with his foot, but the slippers he had on being loose, unfortunately, came off, and the snake bit him on the right foot, just above the great toe. He, however, killed the snake and walked a few steps, when he fell and became quite insensible and was carried by some of the peons to the bungalow. Mr. Edwardes immediately administered some strong doses of brandy and liquor ammonia (wbich I had left with Mr. W. Forster for snake-bite), which made him vomit and brought him to his senses; he was kept awake all night, and brandy and ammonia were administered frequently. On the morning of the 1st ultimo, at 9 a.m., I received the notice and immediately started with a proper supply of medicines to Mahim, and found Mr. Davis, though quite sensible, yet very uneasy; his right foot and leg up to the thigh were very much swollen, and in several places had become blue, especially at the *
The high thick thorn hedge carried across the country by the Customs Department to prevent smuggling. Neither man nor beast can get over or it. through
1872.
[Ja^itaet 1,
bitten part, from which blood was oozing in drops owing to its been previously incised by the knife, and a kind of stone, called zahr-mohra, was applied for the purpose of absorbing the snake poison. The pulse was slow, respiration not difficult, pupils slightly contracted, urine frequent and consisted of pure blood; sputa also frequent and consisted of pure blood; complained of great thirst and feeling of uneasiness throughout the whole body ; stabbing pains now and then at the bitten parts ; stomach very irritable and would not retain anything. Treatment.?Stimulating mixture with liquor ammonia was exhibited every half an hour, which was retained ; the swollen parts were fomented with decoction of meen, which greatly relieved the pain, and reduced the swelling, and the patient was not allowed to sleep. On the morning of the 2nd, he said he felt better, sat down for half an hour on an which was easy chair, and took a little sago, retained; pulse a little improved, but the urine and sputa still mixture continued bloody, though less frequent. Stimulating every second hour, instead of half an hour; fomentation continued. At 2 p.m., he complained of severe pain in the abdomen, which was relieved by hot fomentation, but he made several unsuccessful! attempts to evacuate his bowels. At 5 p.m., he asked to have some chicken broth, and wanted to have an undisturbed sleep, which were allowed, as now it has been more than forty-eight hours since he had been bit. At 10 p.m, a relapse took place; he vomited the broth, mixed with a large quantity of blood, and felt very uneasy and prostrated ; stimulating mixture with liquor ammouia was given, too, frequently every quarter of an hour. At 12 p.m., he again felt worse, suffocation and head-ache ensued; his bed was taken out into the verandah, and the medicine was continued. At 2 a.m., the patient got very weak and insensible; pulse very low, breathing very difficult, convulsions commenced, and he could only be roused by loud calling, and with difficulty could swallow the medicine which was given. At 4 a.m., he became comatose; could not be roused at all, neither could he swallow medicine or water; cold perspiration broke out over the face, eyes depressed, extremities became cold, pulse scarcely perceptible, breathing prolonged and stertorous ; convulsions more frequent; twitching of the right hand and beating of the right foot, the left side of the body became paralysed, eyes insensible to light and congested; involuntary discharge of bloody urine and stools, and at 11 a.m. he breathed his last: his corpse was carried into Rohtuck for interment by his brother, Mr. Davis (Head Clerk, Deputy Commissioner's Office, Kohtuck) who arrived at Mahim at the same time as I did. In conclusion, 1 would beg to state that Mr. Davis solely died of snake-bite, and had no other disease, lie was addicted to
having
opium. Hansi,
10th
October, 1871.
.
/
by
J. Fayrer, M.D., C.S.I.
I am indebted to Major C. A. MoMahon, Officiating Commissioner of Hissar, for the following very interesting account of the bite of bungarus ceruletis, in which cnse of death from hematuria was a prominent symptom, and where life seems to have been prolonged by the internal administration of stimulants. a
From Major C. A. MacMahon to Dr. Fayuer. T enclose an interesting account of a death from snake-bite. Mr. Davis, a customs' patrol, was bitten on the 31st August, (evening) and did not die until 11 a.m. on the 3rd September, having been kept up by ammonia and brandy all that time. The case is interesting, because Mr. Davis bad skilful treatment from the first, and the most approved remedies appear to have been applied. Mr. Davis became perfectly insensible almost immediately after he was bitten (showing that the poison was powerful and active) and yet he was restored, not only to consciousness, by the internal administration of ammonia and brandy, but he became sufficiently well to do some work, and sign some official papers, (the latter part is not mentioned in the the influence of the poison having been accounts I send you) checked for so long, one would hardly have anticipated a fatal termination about sixty-three hours after the poison was received into the system. It almost seems as if when a man is being bitten by a full-grown cobra, or krait, stimulants only postpone the fatal hour. The case is an interesting one, and I shall be glad to hear your opinion on it. The snake was evidently a krait. IIow ignorant men are of what snakes are deadly and what are not! Mr. Davis surely did not know. The two accounts T enclose are by Mr. Edwardes, District Superintendent of Police, Rohtuok, and the Sub-Assistant Surgeon of Hansi. I think they give, taken together, a very full, complete, and accurate account of the case.
THE INDIAN MEDICAL GAZETTE.
12
Statement of Mr. F. N. Edwardes. On the 31st August, 1871, I was on my tour of inspection at police station Mahim in this district, and on the customs line. A Mr. Davis, an assistant patrol, went out patrolling on foot in slippers in the evening, and returned at 8-30 p.m.; as he entered the gate of the compound, lie was bitten on the instep by a small snake, a karite or krait, or kerite. He had time to kill the snake, which was about two feet long, of a yellowish color, ?with blackish stripes across its back with his slipper. On Mr. " thuk" Davis being bitten, he called out to the guard at the (or weighing house,) to bring a lattie, and by the time the men readied a distance of not 100 yards, Mr. Davis was insensible ; they brought him to me at 8-30 p.m., or a few minutes after he was bitten, with the part bitten bleeding and a string tied under his knee, which 1 fancy he himself tied. I gave him ammonia and brandy in a wine-glass, cut the part where he was bitten with a penknife and rubbed ammonia into it; on my giving him the second or third dose and rubbing his foot with ammonia and having him walked about, he came round, and at 9 p.m. was all right and perfectly sensible. I still kept walking him about and giving him small doses of ammonia at short intervals,?first with brandy and afterwards without, as he did not like the brandy. About 10 p.m. I allowed him to sit down in a chair, he then became a little sick, but came round again. I left him at 11 p.m. perfectly sensible, and the only thing he complained of was a pain in his leg. I' was obliged to come into Rohtuck and was myself unwell. Shortly after Mr. Davis was brought in and after he came round, I thought it as well to send for toe customs' native doctor at Hansi, and wrote him a purwanah, ordering him to come to Mahim at once, and on my reaching Rohtuck, I wrote to Mr. Davis' brother, telling him of the case and advising him to go out; he went out on the 1st September, and tells me found his brother very well, but complaining of the leg being tied up and wishing to open it; he remained perfectly sensible and well that day, that night, the next day, the 2nd September, and that about 1 a.m. of 3rd September, began vomiting; at first ho thought it was nothing, but on his vomiting a second time lie got up and attended to him. On his asking his brother how he felt, he said that he found his chest paining him a great deal and complained of suffocation; after this lie tried to vomit again, by putting his finger down his throat, but failed. The native doctor was present, and continued giving ammonia with brandy. He after this once fainted and began to get weaker and weaker, and after about 3 a.m., he did not speak, and died about 11-30 a.m. On the 3rd September, Mr. Davis states, that after he fainted, he got convulsive three times, that on the 2nd September, about 3 or 4 p.m., he remarked that his brother was passing blood in the urine, stools, also from the part bitten, and vomiting. Mr. Davis states that he remarked the blood getting blacker and blacker as death approached.
Rohtuck,
6th
October, 1871.
Statement of case
by
Sub-Assistant Surgeon B. R. Paul.
"With reference to your docket No. 773, dated 9th instant, I have the honor to submit the following particulars of Mr. E. F. Davis's lamentable death, which occurred on the 3rd
ultimo,
at 11
a.m.
On the 31st August, 1871, Mr. Davis after taking his dinner at 8 p.m. with Mr. Edwardes, Assistant Superintendent of Police, Rohtuck, (who had come to Mahim on his tour of inspection) went out patrolling on foot towards the Hansi line, and on his return, not very far from his bungalow, just near the nalca,* he saw a small, thin, black and white snake lying on the road, which lie attonipted to kill with his foot, but the slippers he had on being loose, unfortunately, came off, and the snake bit him on the right foot, just above the great toe. He, however, killed the snake and walked a few steps, when he fell and became quite insensible and was carried by some of the peons to the bungalow. Mr. Edwardes immediately administered some strong doses of brandy and liquor ammonia (wbich I had left with Mr. W. Forster for snake-bite), which made him vomit and brought him to his senses; he was kept awake all night, and brandy and ammonia were administered frequently. On the morning of the 1st ultimo, at 9 a.m., I received the notice and immediately started with a proper supply of medicines to Mahim, and found Mr. Davis, though quite sensible, yet very uneasy; his right foot and leg up to the thigh were very much swollen, and in several places had become blue, especially at the *
The high thick thorn hedge carried across the country by the Customs Department to prevent smuggling. Neither man nor beast can get over or it. through
1872.
[Ja^itaet 1,
bitten part, from which blood was oozing in drops owing to its been previously incised by the knife, and a kind of stone, called zahr-mohra, was applied for the purpose of absorbing the snake poison. The pulse was slow, respiration not difficult, pupils slightly contracted, urine frequent and consisted of pure blood; sputa also frequent and consisted of pure blood; complained of great thirst and feeling of uneasiness throughout the whole body ; stabbing pains now and then at the bitten parts ; stomach very irritable and would not retain anything. Treatment.?Stimulating mixture with liquor ammonia was exhibited every half an hour, which was retained ; the swollen parts were fomented with decoction of meen, which greatly relieved the pain, and reduced the swelling, and the patient was not allowed to sleep. On the morning of the 2nd, he said he felt better, sat down for half an hour on an which was easy chair, and took a little sago, retained; pulse a little improved, but the urine and sputa still mixture continued bloody, though less frequent. Stimulating every second hour, instead of half an hour; fomentation continued. At 2 p.m., he complained of severe pain in the abdomen, which was relieved by hot fomentation, but he made several unsuccessful! attempts to evacuate his bowels. At 5 p.m., he asked to have some chicken broth, and wanted to have an undisturbed sleep, which were allowed, as now it has been more than forty-eight hours since he had been bit. At 10 p.m, a relapse took place; he vomited the broth, mixed with a large quantity of blood, and felt very uneasy and prostrated ; stimulating mixture with liquor ammouia was given, too, frequently every quarter of an hour. At 12 p.m., he again felt worse, suffocation and head-ache ensued; his bed was taken out into the verandah, and the medicine was continued. At 2 a.m., the patient got very weak and insensible; pulse very low, breathing very difficult, convulsions commenced, and he could only be roused by loud calling, and with difficulty could swallow the medicine which was given. At 4 a.m., he became comatose; could not be roused at all, neither could he swallow medicine or water; cold perspiration broke out over the face, eyes depressed, extremities became cold, pulse scarcely perceptible, breathing prolonged and stertorous ; convulsions more frequent; twitching of the right hand and beating of the right foot, the left side of the body became paralysed, eyes insensible to light and congested; involuntary discharge of bloody urine and stools, and at 11 a.m. he breathed his last: his corpse was carried into Rohtuck for interment by his brother, Mr. Davis (Head Clerk, Deputy Commissioner's Office, Kohtuck) who arrived at Mahim at the same time as I did. In conclusion, 1 would beg to state that Mr. Davis solely died of snake-bite, and had no other disease, lie was addicted to
having
opium. Hansi,
10th
October, 1871.
.
/
